For rapid realimentation, an age-appropriate, unrestricted diet is recommended as soon as dehydration is corrected

For breastfed infants, nursing should be continued

Additional ORS, for ongoing diarrheal losses

No routine laboratory tests or medications are recommended

Except, if a patient is living in conditions that are crowded or otherwise conducive to outbreaks of GI disease

Care-takers should be counseled for hand hygiene practices

www.bt.cdc.gov/disasters 14Management of Diarrhea in children

Use of antimicrobials - on a patient-by-patient basis

Even when a bacterial cause is suspected, antimicrobial therapy is NOT usually indicated among children because most cases of acute diarrhea are self-limited and their duration is not shortened by the use of antimicrobial agents. Exceptions to these rules may involve

Premature infants, children who are immunecompromised or have underlying disorders) or Suspicion of sepsis

In the context of an outbreak of shigellosis, cryptosporidiosis, or giardiasis.

Probiotics appear to be a useful adjunct to rehydration therapy in treating acute, infectious diarrhoea in adults and children. More research is needed to inform the use of particular probiotic regimens in specific patient groups.

25Probiotics

Beneficial effects seem to be

Moderate

Strain dose dependent

Significant in watery diarrhea and viral gastroenteritis, but non-existent in invasive, bacterial diarrhea

More evident when treatment with probiotics is initiated early in the course of disease.

The duration of diarrhoea was significantly reduced in the three trials reporting this outcome.

Achievement of a cure by day 5 was similar in both groups. Adverse effects were similar in both groups.

Conclusions some evidence in favour of the use of racecadotril over placebo or no intervention, to reduce the stool output and duration of diarrhoea in children with acute gastroenteritis. However, more data in out-patients are needed. The safety as well as the cost-effectiveness of the therapy should be explored, before routine therapy with racecadotril is recommended

Indian Association of Paediatrics (IAP) Guidelines 2006 on Management of acute diarrhea has not recommended use of Racecadotril. The committee has gone through the existing literature in detail before coming to this decision.

No studies are given to support safety (study sample number is small). Unable to comment on concerns of adverse effects as the data are not adequate

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